Exercise, diet and diabetics

Wednesday

Jul 24, 2013 at 6:00 AM

QI'm 60 pounds overweight and have type 2 diabetes. I want to get healthier, but I just read that it doesn't matter what I do — I'm still headed for heart problems. Is it really a waste to diet and exercise? — Darlene F.

AWhat you read was about the Look AHEAD trial. And headlines like "ADA: Lifestyle Changes Don't Protect Diabetic Heart" and "Weight Loss Fails To Prevent Heart Attacks For Diabetics In Study" make it sound like taking care of yourself is useless. The headlines could not be more WRONG.

It matters a great deal if you diet, exercise, lose weight, decrease your waist size and take your meds so you keep blood sugar levels as close to normal as possible. That slashes your risk for diabetic complications, such as amputation, blindness, kidney disease and stroke, not to mention other problems such as cancer, depression and dementia. The lifestyle intervention programs at Dr. Mike's Cleveland Clinic Wellness Center have seen powerful results from upgrading diet and increasing exercise: 90 percent of participants lose weight and achieve better glucose control; 60 percent take fewer medications; and 10 percent see a reversal in their diagnosis of diabetes. That makes them much healthier — and happier.

The Look AHEAD study may have been comparing two groups of obese participants with type 2 diabetes who reduced (or failed to reduce) the risk of heart disease equally. The so-called control group — some of whom were taking statins and all of whom received counseling about managing diabetes —- may have taken that advice to heart (pun intended). They had results that were almost parallel to the "intervention group," who were put on an upgraded diet and exercise routine and aimed to lose weight. In short, everybody benefited a little.

The "diet and exercise" group did come out AHEAD in some respects: They shed 3 percent more weight, had lower lousy LDL cholesterol and blood pressure, and ended up taking less high blood pressure medication, statins and insulin than members of the "good advice only" group. So the study (and the Cleveland Clinic Wellness Center programs) proves your risk for a whole roster of health problems goes down when you lose weight, control blood sugar and get regular exercise. You'll see that life gets much better as your RealAge gets younger.

QMy sister just went through chemotherapy, and although it seemed to beat her cancer, the treatment almost killed her. Will there ever be a better way to fight cancer? — Katie J.

AChemotherapy is increasingly refined, and yet it still puts every patient through rough times. The good news is that often it's extremely effective. Stage 1 breast cancer, for example, now has a five-year survival rate of almost 90 percent. But a new wave of treatments, called molecular targeted therapy, are around the corner, and for certain cancers some are here already. What they do, or try to do, is destroy only cancerous cells without harming any surrounding, healthy tissue.

Herceptin — a monoclonal antibody used to fight HER-2-positive breast cancer — has been used for many years and is very effective (it cuts recurrence of breast cancer in half, compared with use of chemo alone), but it's useful only against 20 percent of breast cancers. Imatinib, another monoclonal antibody, works on certain types of leukemia by shutting down pathways that cancer cells rely on to function. The latest effective targeted therapy, ibrutinib, is an oral "smart bomb" that works against chronic lymphocytic leukemia and mantle cell lymphoma by blocking a protein (kinase) that cancer cells need to thrive. Every year, there are more-sophisticated, individualized treatments available, and hopefully cancer treatment won't always be so tough to go through.

But we're not just learning how to treat cancers more effectively. Using medications like aspirin, nutrients like DHA omega-3 fatty acid, foods like broccoli and vaccines like the one against HPV, we're learning to prevent some cancers. Glad your sister's OK.

Dr. Mehmet Oz is host of "The Dr. Oz Show," and Dr. Mike Roizen is chief wellness officer and chairman of Wellness Institute at Cleveland Clinic. Email questions to youdocsdaily@sharecare.com.